Quality Assurance Specialist: Ensuring Excellence in Care

1 month ago


Taguig, National Capital Region, Philippines Gratitude Philippines Full time

About Gratitude Philippines


We are a dynamic organization dedicated to delivering exceptional healthcare services. Our team of professionals is passionate about making a difference in the lives of our patients.



Job Description

Role Overview


We are seeking an experienced Quality Assurance Specialist to join our team. The ideal candidate will possess excellent analytical skills, a strong attention to detail, and the ability to communicate effectively with various stakeholders.



Key Responsibilities

  • Conduct regular reviews of Managed Care internal and external claim files to ensure consistency in evaluation of evidence-based medicine and comprehensive assessments.
  • Analyze Quality Assurance reporting metrics to identify strengths and areas for improvement, providing recommendations to support education and training development needs.
  • Measure and identify staffing competency levels from quality assurance reviews, working with leadership and staff to calibrate quality standards across all offices.
  • Collaborate with healthcare professionals to develop and implement quality assurance programs that promote best practices and improve patient outcomes.


Requirements

  • Bachelor's degree in nursing (BSN) or related field.
  • Unrestricted active RN license.
  • Certification in case management, rehabilitation nursing, or related specialty preferred.
  • Minimum two years direct clinical care experience, preferably in trauma, emergency, intensive care, orthopedic, or neurology settings.
  • Written and verbal fluency in English required.
  • Combination of two years in utilization review programs for Group Health or Worker's Compensation or experience in a quality assurance role required.
  • Understanding and prior experience with URAC accreditation for utilization review preferred.


Compensation and Benefits

We offer a competitive salary range of $55,000 - $65,000 per annum, depending on experience. Additionally, you will receive a comprehensive benefits package, including medical insurance, retirement plan, and paid time off.



The estimated salary for this position is around $62,500 per year, based on industry standards and location.



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